Risk scores for predicting postoperative nausea and vomiting are clinically useful tools and should be used in every patient: Con – ‘life is really simple, but we insist on making it complicated’

Abstract

Risk scores to predict the occurrence of post-operative nausea and vomiting (PONV) are used increasingly to guide prophylactic antiemetic administration. Recent consensus guidelines advocate the use of such models by stating that the use of prophylactic antiemetics should be based on a valid assessment of the patient's individual risk. However, there is still a striking gap between proven and effective antiemetic measures and the poor implementation of current knowledge gained in the last decades. One possible reason for this is that many anaesthesiologists are confused about when to administer which antiemetic to a specific patient. Instead of using a liberal approach, too much emphasis has been placed on risk stratification and risk-adapted antiemetic prophylaxis. The aim of this review is to summarise criticism regarding the latter theoretical issues that in daily practice do not facilitate the use of antiemetic measures. Special focus should be centred on the use of PONV scores to guide antiemetic therapy. We feel that these issues have not been addressed adequately in the past and we would like to stimulate a discussion about whether tools for PONV prediction facilitate or hinder the implementation of antiemetic strategies. Given these implementation problems, we strongly advocate the liberal use of a multimodal antiemetic protocol for all patients. Antiemetics have an excellent safety profile and side-effects of these drugs are mainly mild and transient. Patients may even benefit from these side-effects. For example, corticosteroids are co-analgesics and positively affect mood and convalescence in the post-operative period, and droperidol protects against post-operative headache. Acquisition costs of antiemetics are low and, together with post-operative pain management, antiemetic prophylaxis is probably the area in anaesthesia in which the highest impact on patient satisfaction can be achieved with the least costly and time-consuming interventions.